2016 employee benefit guide - Family Health Centers of San Diego

YOUR PATH TO
EXCEPTIONAL
SAFETY
EMOTIONAL
FINANCIAL
PHYSICAL
HEALTH
STARTS HERE
I
2016 EMPLOYEE BENEFIT GUIDE
Table of Contents
GETTING
STARTED
01 02 03 04 Welcome
Benefits-at-a-Glance
Employee Costs
Eligibility and Enrollment
PHYSICAL
06
13
FINANCIAL
Medical
Five plan choices that
offer a range of health
benefits, including free
preventive care.
17
Prescription Drug
Coverage
All of the medical
plans provide
comprehensive
prescription drug
coverage.
19
14
Dental
Three plan choices for
your dental care.
16
Vision
Vision coverage and
additional discounts
for other vision
services.
WRAPPING
UP
30 31
32 33
20
Flexible Spending
Accounts
Health Care and
Dependent Care
accounts.
Life and AD&D
Insurance
Basic Life and AD&D
Insurance for you;
Additional Life
Insurance for you,
your spouse and
dependents.
Disability Insurance
Long Term Disability
insurance for you.
21
Retirement Savings
403(b) and 457(b)
plans to help you save.
22
Additional Benefits
529 College Savings
Fund, Pet Insurance,
Travel Assist, Legal &
Identity Theft Shield,
Aflac Benefits and
Home, Renters & Auto
insurance.
SAFETY
EMOTIONAL
24
Work Life Services
(Employee Assistance
Program)
Confidential help
when you need it,
24/7.
25
FHCSD Wellness
Programs and
resources to help
you on your wellness
journey.
26
Employee Perks
Awards, programs
and discounts for all
FHCSD employees.
28
Time Off
Paid time off,
extended sick
insurance and
holidays to help you
balance work and
home.
Helpful Definitions
Employee Benefits Service Center
Important Notices
Contact Information
29
Safety Starts With Me
Stay safe and earn
rewards!
29
CPR Certification
Classes are offered
every other month.
29
Safety Training
Regular safety
trainings offered
throughout the year.
29
Ergonomics
Free ergonomic
assessments available
for all employees!
WELCOME TO YOUR 2016
EMPLOYEE BENEFITS
An important priority of FHCSD is to provide a competitive employee
benefits program for our valued employees. We know our employees
view their benefits as an important part of total compensation
package.
Laura Rodriguez
Founder
Family Health
Centers of
San Diego
For 2016, we are pleased the benefits offered to our employees and
their families are even more comprehensive than in previous years.
Employees who participate in our wellness program can also earn a
discount on their portion of their medical premiums.
This guide will assist FHCSD employees in making informed
decisions regarding their benefits. The benefits package offers a
variety of coverage options to help our employees choose a plan
that best meets their needs. Please read the guide carefully as it will
help in making benefit choices.
Benefit packages are complex. To help better understanding the
available benefits, Family Health Centers of San Diego partnered
with Intercare Insurance Solutions to offer a hotline for our
employees and their family members. This toll-free number gives
employees immediate and accurate answers to benefit questions.
Employee Benefits Service Center
Extension 4200 or 877.679.2011
champion@intercaresolutions.com
7:00 a.m. to 5:30 p.m. Pacific Time l Monday through Friday
Closed on major U.S. holidays
Regards,
Fran Butler-Cohen
CEO, Family Health Centers of San Diego
Family Health Centers of San Diego (FHCSD) was
established in 1970 as a result of a demonstration
led by community activists and a well-known
grandmother and Barrio Logan resident, Laura
Rodriguez. Laura was involved in many worthy
causes and dedicated her life to improving the
community of Barrio Logan. Most special to her
heart, was “La Clinica”.
After growing up without a neighborhood health
facility, Laura was inspired to lead a movement
to establish a clinic in Barrio Logan for children
in her community. Once the clinic opened, Laura
worked tirelessly for 24 years to ensure its
success. She was known for her famous tamales
and once said, “Making tamales while talking
about the health center’s needs has put me
in contact with hundreds of folks who helped
build our center. After all, Barrio Logan is my
neighborhood. I will give it the best I’ve got.”
Laura had a humble beginning but received many
awards and was recognized as a Presidential
“Point-of-Light”. Today FHCSD is the second
largest federally qualified health center in the
nation, and we honor Laura by fulfilling our
mission to provide caring, affordable, high quality
healthcare and supportive services to anyone in
need.
1
Benefits-at-a-Glance
BENEFIT
COVERAGE OPTIONS
COSTS SHARED BY YOU AND FAMILY HEALTH CENTERS OF SAN DIEGO
•
•
•
•
•
Medical
UnitedHealthcare SignatureValue Advantage HMO (Limited Network)
UnitedHealthcare SignatureValue HMO (Full Network)
Kaiser Permanente HMO
SIMNSA HMO
UnitedHealthcare PPO with HSA
100% OF COSTS PAID BY FAMILY HEALTH CENTERS OF SAN DIEGO
Basic Life and AD&D
Long Term Disability (LTD)
Work Life Services
Employee Assistance Program
• The Standard - Benefit is equal to 2x annual earnings to a minimum of $40,000
and a maximum of $500,000.
• The Standard - Benefit is equal to 50% of monthly salary to a maximum of
$10,000/month for up to 24 months.
• The Standard - Up to 3 face-to-face counseling sessions per incident for you or
any member of your household.
100% OF COSTS PAID BY YOU
Dental
• United Concordia DHMO
• United Concordia PPO
• SIMNSA DHMO
Vision
• Vision Service Plan PPO
Additional Life Insurance
Enhanced Long Term Disability
(LTD)
• The Standard - The minimum you can elect is $10,000. Coverage is available
in $10,000 increments up to a maximum of $500,000. Spouse and child(ren)
coverage is also available.
• The Standard - Benefit is equal to 60% of monthly salary to a maximum of
$12,000/month up to the current retirement age (age 65).
• Contribute up to $2,500 pre-tax dollars per year for eligible healthcare
Flexible Spending Accounts
(FSA)
expenses.
• Contribute up to $5,000 pre-tax dollars per year for eligible dependent care
expenses.
Additional Benefits
• Aflac Supplemental Benefits
• LegalShield and Identity Theft Shield
• VPI Pet Insurance
RETIREMENT BENEFITS
• Principal Financial Group - You may contribute up to 50% of your pre-tax
403(b) Retirement Plan
earnings up to the 2016 federal maximum of (additional catch-up contribution
is available if you turn age 50 or over anytime during the year).
• FHCSD matches 50% of your contributions up to 10% of your pay.
457(b) Retirement Plan
2
• Principal Financial Group - You may contribute up to 100% of your pre-tax
earnings up to the 2016 federal maximum.
Employee Costs
FHCSD cares about your health and well-being and is pleased to offer an employee Wellness Program. We believe
participation in the Wellness Program will lead to better health. All employees will pay medical contribution amounts
shown below. Employees who participate in the Wellness Program each quarter will earn a $25 credit each paycheck
towards the cost of their medical plan during the next quarter! Medical contributions are taken out of all paychecks except
for 4/29/2016 and 9/30/2016 paychecks.
Wellness Participants can
save $25 per pay period!
TOTAL COST
PER YEAR
TIER
TOTAL COST
PER PAY PERIOD
FHCSD COST
PER PAY PERIOD
YOUR COST
PER PAY PERIOD
SIMNSA HMO
Employee Only
$2,147.40
$89.48
$59.48
$30.00
Employee + 1 Dependent
$3,833.40
$159.73
$127.23
$32.50
Employee + Family
$6,643.32
$276.81
$241.81
$35.00
KAISER PERMANENTE HMO
Employee Only
$5,201.52
$216.73
$170.73
$46.00
Employee + 1 Dependent
$11,183.16
$465.97
$360.97
$105.00
Employee + Family
$15,344.28
$639.35
$494.35
$145.00
UNITEDHEALTHCARE SIGNATUREVALUE ADVANTAGE NETWORK HMO ( LIMITED NETWORK )
®
Employee Only
$6,470.40
$269.60
$223.60
$46.00
Employee + 1 Dependent
$13,909.56
$579.57
$474.57
$105.00
Employee + Family
$19,084.32
$795.18
$650.18
$145.00
UNITEDHEALTHCARE SIGNATUREVALUE HMO ( FULL NETWORK )
®
Employee Only
$9,704.76
$404.37
$337.37
$67.00
Employee + 1 Dependent
$20,864.40
$869.35
$674.35
$195.00
Employee + Family
$28,627.92
$1,192.83
$937.83
$255.00
UNITEDHEALTHCARE PPO WITH HSA
Employee Only
$8,315.16
$346.47
$291.47
$55.00
Employee + 1 Dependent
$17,875.80
$744.83
$594.83
$150.00
Employee + Family
$24,525.96
$1,021.92
$826.92
$195.00
Dental and vision contributions are not impacted by your participation in the health screening or in any wellness programs.
TIER
Employee Only
UNITED
UNITED
SIMNSA
CONCORDIA CONCORDIA
DHMO
DHMO
DPPO
YOUR COST PER PAY PERIOD
TIER
VSP VISION PLAN
YOUR COST PER PAY
PERIOD
Employee Only
$4.01
Employee + Spouse
$6.87
$7.02
$7.30
$18.09
$7.66
Employee + 1 Dependent
$13.12
$33.93
$13.79
Employee + Child(ren)
Employee + Family
$22.78
$55.19
$23.92
Employee + Family
$11.31
When any insurance policy or other benefit program provides that benefits continue through the end of the month in which
you terminate or are no longer benefit-eligible, your share of the cost for the remainder of the month will be deducted from
your paycheck and coverage will continue through the end of the month in which you terminate or lose coverage.
3
Eligibility & Enrollment
Who Can Enroll?
Regular Employees
• Working full-time (30 hours or more each week on a regular basis).
• Temporary and variable hour employees regularly working 30 or
more hours per week are eligible for medical insurance only.
Spouse/Registered Domestic Partner
• Your legally married spouse (same or opposite sex).
• Your California registered domestic partner (as defined by
California Family Code Section 297).
Children
• Your children, stepchildren or children of your registered domestic
partner to age 26, regardless of marital or student status.
• Any children for whom you are required to provide coverage under
a Qualified Medical Child Support Order.
• Disabled Child: your unmarried children, step-children or children
of your registered domestic partner of any age, if they are incapable
of self-care due to a physical or mental disability.
Our benefits plan year is from
January 1 to December 31.
Refer to the carrier documents for enrollment requirements.
Your spouse, registered domestic partner and children can be enrolled
in our medical, dental, vision, supplemental life insurance plans and
LegalShield and Identify Theft Shield.
Required Information
• At enrollment you will need to enter the Social Security Number for all covered dependent(s).
• Health Care Reform requires FHCSD to report this health plan information to the IRS each year to show that you and
your dependents have coverage and are not subject to a penalty.
Your personal information will be securely submitted to the IRS and will remain confidential.
Who Pays?
When Can I Enroll?
FHCSD and You
Open Enrollment
FHCSD pays most of the cost of medical
coverage for you and your eligible spouse,
registered domestic partner and/or children.
The amount you pay for medical, dental and
vision is taken from your paycheck before
federal and state taxes are taken out. This can
help reduce the amount of taxes you pay.
• During open enrollment you can add, cancel or change coverage for
you and your eligible family members.
4
• Open enrollment is November 1 - November 15 every year.
New Hire
• You are eligible to enroll on the first of the month following 30
days of employment, not to exceed 60 days.
Example: if you start working at FHCSD on March 15, your benefits start on May 1.
Eligibility & Enrollment
When Can I Change My Benefits?
Open Enrollment
• During open enrollment you can make changes to your benefits – like choosing a different medical plan or enrolling
or re-enrolling in the Flexible Spending Account plans.
Qualifying Event
• You can make changes during the plan year if something in your life changes (and is an event recognized by the IRS),
such as:
Marriage, divorce,
legal separation
Loss of other coverage
for your dependent
Birth, adoption, death
Change in residence
causing loss of coverage
Medicare or Medicaid entitlement
for you, your spouse or dependent
Change in employment, eligibility, or
cost of benefit coverage for you, your
spouse or dependent
Reduced hours at work
for you or your spouse
Qualified Medical Child
Support Order (QMCSO)
• You’ll document qualifying event changes in the online Benefit Enrollment System. You must notify Human
Resources, and provide documentation, within 30 days of the qualifying event. Any benefit plan election change must
be consistent with the qualifying event. Benefit election decisions will then remain in force for the remainder of the
plan year.
How Can I Enroll?
Enroll Online at www.vbas.com
• Your User Name is FHCSD and your four digit employee badge number (write yours here: FHCSD__ __ __ __).
First time users: your temporary password is Benefit followed by the last four digits of your Social Security number and
your four digit birth year; example:
Social Security number: 123-45-6789
Birth year: 1979
Password = Benefit67891979
You will be asked to change your password once you login for the first time.
• Call 4200 or 877.679.2011 if you have forgotten your password.
5
Medical Plan Choices
HMO Plans
A Health Maintenance Organization (HMO) offers you a
range of health benefits, including free preventive care.
You have the choice to enroll in one of four HMO plans.
With any of the HMO plans, you must see doctors and visit
hospitals in the network. Except for emergency and urgent
care, if you obtain care outside the HMO’s network without
a referral, you will have to pay the full cost of services.
UnitedHealthcare HMO
You have the option to select the UnitedHealthcare
SignatureValue Advantage HMO or the UnitedHealthcare
SignatureValue HMO (Full Network).
• You and your covered dependents must select the
same HMO plan.
• Whichever HMO you choose, you must select a primary
care physician (PCP) from a list of doctors provided by
the HMO.
• Your PCP coordinates all your care, including referrals
to specialists and approving further medical treatment.
• Each family member may choose his/her own PCP.
• UnitedHealthcare covers treatment for infertility
services for the diagnosis of an underlying condition
only.
SignatureValue Advantage HMO (Limited Network)
COVERAGE INFORMATION & DOCTOR
SEARCHES AT YOUR FINGERTIPS!
Just log on to www.uhcwest.com
from your smartphone browser
and begin using it to search
for doctors, access health and
wellness resources, and order a
health plan ID card.
• Same high quality care as the SignatureValue HMO
(Full Network).
• A slightly more limited network of providers means you
will pay less for your medical care.
• No access to providers at Scripps Coastal Medical
Group, Scripps Clinic and UCSD.
SignatureValue HMO (Full Network)
• UnitedHealthcare’s complete network of HMO
physicians.
• Higher copayments and higher monthly contributions.
• Access to many providers including Scripps Coastal
Medical Group, Scripps Clinic and UCSD.
6
Medical Plan Choices
Kaiser Permanente HMO
As a member of Kaiser Permanente, you are encouraged to
select a primary care physician, but it is not a requirement.
• Choose your personal doctor. You’re free to change at
anytime, for any reason.
• With Kaiser doctor profiles you have access to all the
information you need to make the right doctor match.
• Each family member may choose his/her own doctor.
• Access to the full Kaiser health system
• Most locations include pharmacy, lab, X-ray services,
and more
GOOD HEALTH IS IN YOUR HANDS
My Health Manager is your
one-stop online resource
for time-saving features.
Use it to email your doctor,
refill prescriptions, view
appointments, and more!
Just download the Kaiser Permanente app for
the iPhone, iPad, or iPod touch from the App
Store or for Android from Google Play.
Bookmark www.kp.org on your Web-enabled
phone or mobile device.
Most services are covered at 100% after you pay a
copayment. There is no deductible with the HMO and no
claim forms for you to submit. Additionally, Kaiser is the
only medical plan option that provides coverage for the
treatment of infertility.
Retiree Coverage
FHCSD retirees who are age 65 or older have the option
to purchase Retiree Medical Coverage through Kaiser. This
Retiree Medical Plan offers enhanced benefits. Retirees
may also include coverage for their eligible dependents
who are age 65 or older. Please call the Employee Benefits
Service Center at extension 4200 or 877.679.2011 or for
additional information.
7
UnitedHealthcare & Kaiser
Medical Plan Highlights
UNITEDHEALTHCARE
SIGNATUREVALUE®
ADVANTAGE NETWORK
HMO ( LIMITED NETWORK )
UNITEDHEALTHCARE
SIGNATUREVALUE®
HMO ( FULL NETWORK )
KAISER
PERMANENTE
HMO
None / None
None / None
None / None
$2,000 / $6,000
$3,000 / $9,000
$1,500 / $3,000
No Charge
No Charge
No Charge
$20 Copay (PCP);
$40 Copay (Specialist)
$20 Copay (PCP);
$40 Copay (Specialist)
$20 Copay (PCP);
$40 Copay (Specialist)
Therapy*
$20 Copay
$20 Copay
$20 Copay
Laboratory and X-Rays - Standard
No Charge
No Charge
No Charge
Complex X-Rays - CT, MRI, PET
$50 Copay
$200 Copay
No Charge
Maternity Care
No Charge
$20 Copay
No Charge
Not Covered
Not Covered
50% Per Visit
$15 Copay
$15 Copay
$15 Copay
Inpatient Hospital
$250 Copay Per Admission
$400 Copay Per Admission
$250 Copay Per Admission
Outpatient Surgery
$125 Copay
$400 Copay
$100 Per Procedure
Emergency Room
$100 Copay
$150 Copay
(Waived if Admitted)
$100 Copay
(Waived if Admitted)
$40 Copay;
$100 Copay (Out of Area)
$40 Copay;
$75 Copay (Out of Area)
$20 Copay
$50 Copay
$50 Copay
$50 Copay
$250 Copay Per Admission
$250 Copay Per Admission
$250 Copay Per Admission
$40 Copay
$40 Copay
$20 Per Visit
FEATURES
CALENDAR YEAR DEDUCTIBLE
Individual / Family
OUT- OF - POCKET MAXIMUM
Individual / Family
PREVENTIVE
Preventive Care Services
Adult Routine Physicals
Well-Woman Care
Well-Baby Preventive Care
Routine Check-ups (Ages 2-18)
Immunizations @ PCP
PHYSICIAN SERVICES
PCP/Specialist Office Visits
Infertility Services
Chiropractic1
HOSPITAL SERVICES
Urgent Care Services
Ambulance
MENTAL HEALTH
Mental Health Inpatient
Mental Health Outpatient
*
1
Outpatient Medical Rehabilitation Therapy (Physical, Occupational and Speech)
Limited to 20 visits/year.
8
SIMNSA Medical Plan
SIMNSA Baja HMO
FEATURES
The SIMNSA Baja HMO is an HMO available only to
Mexican Nationals. A Mexican National is defined as:
a. a person born in Mexico;
b. a person born in another country with a Mexican
father or a Mexican mother, or both;
c. a foreign woman or man who marries a Mexican
man or woman and lives in Mexico; or
d. a foreigner who becomes naturalized in Mexico.
SIMNSA HMO
CALENDAR YEAR DEDUCTIBLE
Individual/Family
None
OUT- OF - POCKET MAXIMUM
Individual/Family
$6,350/$12,700
PREVENTIVE
Preventive Care Services
Adult Routine Physicals,
Well-Woman Care
Well-Baby Preventive Care
Routine Check-ups (Ages 2-18)
Immunizations @ PCP
Features of this plan include:
• Comprehensive medical coverage that includes
preventive care and fixed copays for most services.
No Charge
PHYSICIAN SERVICES
• No annual deductible or lifetime dollar maximum.
• The ability to choose your own SIMNSA personal
physician who will be responsible for providing
or coordinating all of your medical care, including
specialty care referrals.
PCP/Specialist Office Visits
$7 Copay
Therapy1
$10 Copay
Laboratory and X-Rays - Standard
No Charge
Complex X-Rays - CT, MRI, PET
No Charge
Maternity Care
• Ability to access all non-Mexico urgent care centers,
including FHCSD clinics, for an Out of Area copay.
$7 Copay
Infertility Services
Not Covered
Chiropractic2
Not Covered
HOSPITAL SERVICES
Inpatient Hospital
No Charge
Outpatient Surgery
No Charge
Emergency Room
Urgent Care Services
Ambulance
$100 Copay (Waived if
Admitted)
$25 Copay;
$50 Copay (Out of Area)
No Charge
MENTAL HEALTH
Mental Health Inpatient
Mental Health Outpatient
No Charge
$7 Copay
PRESCRIPTION
Retail
Mail Order
$10 Copay
Not Covered
Outpatient Medical Rehabilitation Therapy (Physical, Occupational and
Speech)
2
Limited to 20 visits/year.
1
9
Medical Plan Choices
UnitedHealthcare PPO with HSA
• A PPO medical plan option that gives you more choice and control over how you receive and pay for medical care
and services.
• Employees enrolled in the PPO with HSA cannot enroll in the Health Care Flexible Spending Account (FSA).
• This plan is made up of two parts:
1. PPO Health Plan - With the PPO, you pay the
full cost of your medical and prescription drug
expenses up to the calendar year deductible
amount, before the plan starts to pay (deductible
is waived for in-network preventive care services).
• After you meet the deductible, the plan shares
the cost of eligible expenses. Generally, you’ll
pay coinsurance. This can be paid for from your
HSA as long as there’s money in the account.
• Family Coverage
The PPO has a collective family deductible and
out-of-pocket maximum. This means that all
family members contribute towards the family
deductible and out-of-pocket maximum. The
plans cannot pay an individual’s claims until
the total family deductible has been met, even
if he or she has met the individual deductible.
Once the family deductible limit has been
satisfied, future claims by all members will be
covered at the coinsurance level.
How to Open Your HSA Bank Account
• You must open an account through HSA Bank in order
to receive the FHCSD seed money.
• Once you’ve enrolled in the HSA plan (and after your
benefits effective date) you will need to go online and
open a bank account with HSA Bank.
• Human Resources will provide you with the online link
or paper application.
• Your account is typically opened within 1-2 business
days.
• A welcome kit and your account debit cards will arrive
within 7-10 days of opening the account.
• If you have banking/account related questions
please contact HSA Bank at 800.357.6246 or visit
www.hsabank.com.
10
2. Health Savings Account (HSA) - When you enroll in the
PPO with HSA plan, you have the opportunity to open
an HSA. An HSA is a personal savings account that
allows you to save and pay for qualified health-related
expenses on a pre-tax basis. Here are some of the
advantages of an HSA:
• FHCSD will contribute seed money for the 2016
plan year.
• Employee Only - $1,500
• Employee + Dependent(s) - $3,000
• 20% of FHCSD’s contribution will be deposited
on your effective date; the remaining 80% will be
deposited over 24 pay periods for the rest of the
calendar year. New hire contributions are prorated
based on your benefits effective date.
• You also have the ability to contribute to the
account. Between FHCSD and you, the maximum
annual contribution for 2016 is:
• Employee Only - $3,350
• Employee + Dependent(s) - $6,750
• Contributions, interest earnings and withdrawals
for qualified health- related expenses are excluded
from Federal income tax and FICA (Social Security
and Medicare).
• There is no “use it or lose it” rule. Unused funds
roll over each year.
• Unused funds can grow through interest and
investment earnings and can be “banked” for
future health-related expenses.
• The HSA moves with you when you change
medical plans, change employers or retire.
• You decide when to use your HSA funds to pay for
qualified health- related expenses.
• Your HSA funds can be used in retirement for
eligible health related expenses, including
Medicare expenses.
UnitedHealthcare Medical Plan Highlights
FEATURES
UNITEDHEALTHCARE PPO WITH HSA
IN - NETWORK
OUT- OF - NETWORK
CALENDAR YEAR DEDUCTIBLE (COMBINED MEDICAL & PHARMACY )
Individual / Family
$1,500 / $3,000
$3,500 / $7,000
OUT- OF - POCKET MAXIMUM ( INCLUDES DEDUCTIBLE, COPAYS AND COINSURANCE )
Individual / Family
$2,500 / $5,000
$4,500 / $9,000
FHCSD WILL SEED EMPLOYEE HSA FOR 2016
Individual / Family
$1,500 / $3,000
PREVENTIVE
Preventive Care Services
Adult Routine Physicals
Well-Woman Care
Well-Baby Preventive Care
Routine Check-ups (Ages 2-18)
Immunizations @ PCP
No Charge
Not Covered
PCP/Specialist Office Visits
10% After Deductible
30% After Deductible
Therapy*
10% After Deductible
30% After Deductible
Laboratory and X-Rays - Standard
10% After Deductible
30% After Deductible
Complex X-Rays - CT, MRI, PET
10% After Deductible
30% After Deductible
Maternity Care
10% After Deductible
30% After Deductible
Not Covered
Not Covered
10% After Deductible
30% After Deductible
Inpatient Hospital
10% After Deductible
30% After Deductible
Outpatient Surgery
10% After Deductible
30% After Deductible
PHYSICIAN SERVICES
Infertility Services
Chiropractic
1
HOSPITAL SERVICES
Emergency Room
Urgent Care Services
Ambulance
10% After Deductible (Waived if Admitted)
10% After Deductible
30% After Deductible
10% After Deductible (Prior Authorization Required for Non-Emergency)
MENTAL HEALTH
1
Mental Health Inpatient
10% After Deductible
30% After Deductible
Mental Health Outpatient
10% After Deductible
30% After Deductible
Limited to 24 visits/year.
How the HSA works
• You open a Health Savings Account (HSA), established through FHCSD with HSA Bank that you and FHCSD
can put money into (details on how to open your HSA are provided separately).
• You visit a doctor or other health care provider and after your visit, UnitedHealthcare gets a bill.
• UnitedHealthcare sends you an explanation of benefits (EOB). It shows how much you owe for your services.
• You will get a bill for the balance owed to the doctor after your health plan has paid for services.
• Use the money in your HSA to cover out-of-pocket costs. Then use your own money to reach the full amount
of the deductible before the plan coinsurance begins to pay for covered services.
11
Free Medical Care
All medical plans cover preventive care services, for enrolled members, that meet the requirements of federal and state
law, including certain screenings, immunizations and physician visits. If you visit in-network providers, you don’t have to
pay for preventive care services. If you use an out-of-network provider, a charge may apply.
Child Preventive Care (Birth to 18 years)
Adult Preventive Care (Age 19 and older)
Preventive Physical Exam
Age-appropriate screening tests may include:
• Newborn screenings
• Vision screening
• Hearing screening
• Developmental and behavioral assessments
• Oral health assessment
• Screening for lead exposure
• Height, weight and body mass index (BMI)
• Screening for sexually transmitted infections
Preventive Physical Exams
Age-appropriate screening tests may include:
• Cholesterol screening for high risk adults
• Blood pressure
• Screening for depression
• Type 2 Diabetes screening for adults with high blood
pressure
• Breast cancer screening, including exam and
mammography
• Screening for sexually transmitted infections
• HIV screening
• Osteoporosis screening
• Colorectal cancer screening
• Intervention services (includes counseling and
education):
• Screening and counseling for obesity
• Genetic counseling for women with a family
history of breast or ovarian cancer
• Behavioral counseling to promote a healthy diet
• Primary care intervention to promote
breastfeeding
• Screening and behavioral counseling related to
tobacco use
• Screening and behavioral counseling related to
alcohol misuse
Immunizations:
• Hepatitis A
• Hepatitis B
• Diphtheria, Tetanus, Pertussis
• Varicella (chicken pox)
• Influenza (flu)
• Pneumococcal (pneumonia)
• Human Papillomavirus (HPV)
• Haemophilus Influenza type B (Hib)
• Measles, Mumps, Rubella (MMR)
• Meningococcal (meningitis)
Immunizations:
• Hepatitis A
• Hepatitis B
• Varicella (chicken pox)
• Influenza (flu)
• Pneumococcal (pneumonia)
• Human Papillomavirus (HPV)
• Measles, Mumps, Rubella (MMR)
• Meningococcal (meningitis)
This is not a contract or policy. This list is not a contract with UnitedHealthcare, Kaiser and SIMNSA. If there is any difference between this sheet and the group policy,
the provisions of the group policy will govern. Please talk with your doctor about specific health guidelines. This summary of preventive care and physical exam
benefits is a brief overview. Preventive Health Guidelines reflected in this document are recommendations for individuals of average risk. Individuals who are higherrisk, including but not limited to those in certain racial/ethnic groups or with personal/family medical history, should check with his/her health care provider for
preventive health guidance. Please see your Summary Plan Description as amended, for coverage exclusions and limitations.
12
Prescription Drug Coverage
UnitedHealthcare
UnitedHealthcare members can utilize both retail pharmacy and mail order
pharmacy services.
Mail Order
If you take maintenance medications for chronic conditions, such as high
blood pressure, asthma or diabetes, using the mail order service can save
time and money. When using the mail order service, you will receive a
3-month supply for the cost of 2 months!
Save Money On Your Medications
You can order refills:
Online - www.optumrx.com
Ask For Generic Drugs
You can save money by asking for generic
drugs. The FDA requires that generic
drugs have the same high quality,
strength, purity, and stability as brandname drugs.
By Phone - 800.562.6223
By Mail - Complete the Order or Reorder Form and mail with payment
in full to the address listed on the form.
Retail Pharmacy
• Show your medical plan ID card at a participating pharmacy.
The next time you need a prescription,
ask your doctor to prescribe a generic
drug when it is available and appropriate.
• Your cost will depend on the type of prescription you receive.
• You will receive a 30-day supply for your prescription.
FEATURES
UNITEDHEALTHCARE
SIGNATUREVALUE®
ADVANTAGE NETWORK
HMO
( LIMITED NETWORK )
UNITEDHEALTHCARE
PPO WITH HSA
UNITEDHEALTHCARE
SIGNATUREVALUE®
HMO
( FULL NETWORK )
IN - NETWORK
OUT- OF - NETWORK
RETAIL PHARMACY COPAYMENT ( UP TO A 30- DAY SUPPLY )
Generic
$10
$10
$10 After Deductible
$10 After Deductible1
Brand Name
$25
$25
$30 After Deductible
$30 After Deductible1
Non-Formulary
$35
$35
$50 After Deductible
$50 After Deductible1
MAIL ORDER COPAYMENT ( UP TO A 90- DAY SUPPLY )
1
Generic
$20
$20
$25 After Deductible
Brand Name
$50
$50
$75 After Deductible
Non-Formulary
$70
$70
$125 After Deductible
Not Covered
You pay the copay ment amount plus the difference between the cost of the drug when purchased in-network vs. out-of-network.
Kaiser Permanente
Kaiser members can utilize both retail pharmacy and mail
order pharmacy services. Kaiser members will coordinate
prescriptions through Kaiser Permanente. Prescriptions can
be filled at a retail pharmacy or online at www.kp.org.
Mail Order
Using the mail order service can save you time and money.
You can receive up to a 100-day mail order supply for
maintenance medications.
FEATURES
KAISER PERMANENTE HMO
RETAIL PHARMACY COPAYMENT ( UP TO A 30- DAY SUPPLY )
Generic
$10
Brand Name
$25
Non-Formulary
Not Covered
MAIL ORDER COPAYMENT ( UP TO A 100- DAY SUPPLY )
Generic
$20
Brand Name
$50
Non-Formulary
Not Covered
13
Dental Plan Choices
Strong teeth and gums are an important part of good health, which is why FHCSD
offers you a choice of dental plans to help pay for many of the dental expenses you
and your family may have.
All the plans help you pay for most necessary dental services and supplies, including:
• Diagnostic and preventive care (such as exams, cleanings, and x-rays),
• Basic and major services (such as fillings, crowns, and dentures).
The DPPO features UCWellness, a dental wellness program that provides enhanced
coverage and targeted education for members with pregnancy, diabetes, heart disease
and stroke.
Review the comparison chart below for a summary of plan features.
The United Concordia Dental PPO plan is accepted with certain dentists at
FHCSD Dental Clinic locations.
FEATURES
UNITED CONCORDIA
DHMO
IN - NETWORK ONLY
UNITED CONCORDIA DPPO
IN - NETWORK
OUT- OF - NETWORK*
CALENDAR YEAR DEDUCTIBLE
Individual / Family
None
$50 / $150
None
$1,500***
CALENDAR YEAR MAXIMUM
Per Person
PREVENTIVE & DIAGNOSTIC CARE ( DEDUCTIBLE WAIVED)
Routine Exams, Teeth Cleaning, Bitewing X-rays
No Charge
You pay 0%
You pay 0%
Refer to Schedule
of Benefits**
You pay 10%
You pay 20%
Refer to Schedule
of Benefits**
You pay 40%
You pay 50%
BASIC CARE
Oral Surgery, Endodontics, Fillings
MAJOR CARE
Inlays, Onlays, Crowns
Orthodontia
24-Month Treatment Fee
$1,500/Child $2,000/
Adult
Not Covered
*When using a non-PPO (out-of-network) provider, you pay your coinsurance plus any amount over the prevailing charge, which is the price most providers in the
geographic area charge for a specific service.
**You can find the full schedule of benefits on the Online Benefit Enrollment System.
***Preventive Incentive: Preventive care services do not count toward the calendar year maximum
14
SIMNSA Dental Plan
SIMNSA DHMO
The SIMNSA DHMO is a Dental HMO available only to Mexican Nationals.
A Mexican National is defined as:
a. a person born in Mexico;
b. a person born in another country with a Mexican father or a Mexican
mother, or both;
c. a foreign woman or man who marries a Mexican man or woman and
lives in Mexico; or
d. a foreigner who becomes naturalized in Mexico.
There is no deductible or calendar year maximum. Most diagnostic and
preventive procedures are covered at no cost to you, however other services
may have a copay associated with them.
FEATURES
SIMNSA DHMO
IN - NETWORK ONLY
CALENDAR YEAR DEDUCTIBLE/MAXIMUM
Calendar Year Deductible (Individual/Family)
None
Calendar Year Maximum Benefit per Person
None
PREVENTIVE & DIAGNOSTIC CARE ( DEDUCTIBLE WAIVED )
Routine Exams, Teeth Cleaning, Bitewing X-rays
100%
BASIC CARE
Oral Surgery, Endodontics, Fillings
Refer to Schedule of Benefits**
MAJOR CARE
Inlays, Onlays, Crowns
Orthodontia
Refer to Schedule of Benefits**
24-Month Treatment
$50/Visit
**You can find the full schedule of benefits on the Online Benefit Enrollment System.
15
Vision Plan
FHCSD provides vision coverage through Vision
Service Plan (VSP). VSP has one of the largest
networks of private practicing optometrists,
ophthalmologists and opticians.
• You can see a VSP in-network provider or an outof-network provider.
• Your costs will be lower if you visit an in-network
provider.
• You will not receive a VSP I.D. card as it is not
required to receive service.
• Just call a VSP network doctor to schedule an
appointment and be sure to tell them you are a
VSP member. The doctor and VSP will handle the
rest!
To locate and select a VSP provider, visit www.vsp.com
or call Customer Service at 800.877.7195.
FEATURES
VISION SERVICE PLAN
OUT- OF - NETWORK
IN - NETWORK
REIMBURSEMENT
Materials Copay
$20 Copay
Exam
Once Every 12 Months
$20 Copay
$20 Copay, Then
Plan Pays Up To $45
Lenses
Once Every 12 Months
After Materials Copay, You Pay:
After Materials Copay, Plan Pays:
Single Vision
Bifocal
Up to $30
No Charge
Trifocal
Frames
Once Every 24 Months
Up to $50
Up to $65
Plan Pays Up To $130 (Retail) +
20% Off the Amount Over Your Allowance
Plan Pays Up To $70 (Retail)
Contact lens exam (fitting & evaluation)
Plan Pays Up To $60
Plan Pays Up To $45
Materials (contacts)
Plan Pays Up To $150
Plan Pays Up To $105
Contact Lenses (Instead of Glasses)
Once Every 24 Months
Special Discounts!
In addition to the vision benefits provided through your FHCSD benefits program, VSP offers
special discounts on a number of non-covered services, such as:
• Additional pairs of glasses
• Special lens options
• LASIK surgery
16
Flexible Spending Accounts
What is a Flexible Spending Account (FSA)?
• The FSA, administered by WageWorks, is an account that allows you to
save money to use for certain health care and dependent care costs.
• You can enroll in the health care account, the dependent care
account, or both.
• The money in the account is only available one year at a time
(January 1 - December 31).
How does an FSA work?
• You put money into the account through your paycheck, before any
Federal, State, and Social Security taxes are taken out.
• These deductions are taken throughout the year in equal amounts.
• For example, if you decide to put $500 into an FSA, you’ll have
$20.83 taken out of 24 paychecks and put into your account.
• The best part? FHCSD does it for you, so you don’t have to worry
about transferring money!
• Employees enrolled in the PPO with HSA cannot enroll in the Health
Care Flexible Spending Account (FSA).
Account Details
How do I use the money?
Should I keep my receipts?
When you have an eligible expense, you can:
Yes. You may be occasionally asked to submit your
receipt as proof of an eligible expense. Remember
to keep original receipts for your records as you
may be required to provide documentation directly
to the IRS in the event of a personal tax audit.
• Submit a claim for reimbursement and;
• choose to receive a check by mail or,
• have a direct deposit to your checking or savings
account.
• Have funds automatically deducted from your account by
using your FSA Benefits Card.
• The Benefits Card can only be used with your Health
Care FSA dollars.
• You must submit receipts for reimbursement for your
Dependent Care expenses.
• The FSA Benefits Card deducts each payment directly
from your FSA account.
Your Health Care and Dependent Care accounts function
separately. You cannot use funds from one account to pay for
eligible expenses from the other account (for example, using
Dependent Care account funds for health care expenses).
How long can I access the money in the
account?
Any money that you set aside for your Dependent
Care account and do not use for claims incurred
through December 31, 2016 will be forfeited.
For the Health Care account, money in excess of
$500 that is not used will be forfeited. A new IRS
rule allows you to keep up to $500 of unused
Healthcare FSA funds and roll it into the next
year’s FSA. The rollover has no impact on your
maximum annual election. The rollover amount
is in addition to your regular election for the
following plan year.
17
Health Care FSA
Dependent Care FSA
How much can I contribute?
Can I save money on child care?
• You can put up to $2,500 per year into the Health
Care FSA.
• Yes. Consider enrolling in the Dependent Care FSA.
• If you are married and filing your tax return separately,
each spouse can put up to $2,500 per year into their
own Health Care FSA.
How much can I contribute?
Who can I use the money for?
• If you are married and filing your tax return separately,
you can put up to $2,500 per year into the Dependent
Care FSA.
• You
• Your legal spouse
• You can put up to $5,000 per year into the Dependent
Care FSA.
• Your dependent children
Who can I use the money for?
What can I use the money for?
• Children under the age of 13 who are listed as
dependents on your income tax return.
• Deductibles and copayments
• Medically necessary maintenance and support devices
• Treatment of alcoholism or drug dependency
• Dental, vision and hearing: dental checkups,
orthodontics, glasses, LASIK and hearing aids
(including batteries)
MOBILE ACCESS
Visit m.wageworks.com on your mobile device to:
• Access FSA account balances
• Receive account alerts
• View important dates
Or download WageWorks’ FREE EZ Receipts® app
You can submit receipts and claims from your
mobile device using an easy step-by-step
process and will receive a confirmation once
your claim has been submitted.
18
• Dependents of any age who are incapable of caring
for themselves and who regularly spend at least 8
hours a day in your home.
• Daycare expenses are defined as those that are
necessary in order for you (and your spouse, if you’re
married) to continue working.
What can I use the money for?
Eligible Dependent Care expenses, covered while you are
at work, include:
• Babysitters
• Day Care Centers
• Nursery School/Preschool
• After School Care Programs
BENEFICIARY:
a person or group
that receives
benefits, funds
or other property
under a will, trust,
insurance policy, etc.
Life and AD&D Insurance
Basic Life Insurance (paid by FHCSD)
Life insurance protects your family or other beneficiary(s)
in the event of your death while you are still actively
employed at FHCSD. Your coverage amount will be paid to
the beneficiary(s) of your choice.
What is the Basic Life Benefit?
FHCSD pays for coverage in the amount of:
• Two times your annual earnings
• The benefit amount is a minimum of $40,000 to a
maximum of $500,000
Accidental Death & Dismemberment (paid by
FHCSD)
If your death is due to an accident, your beneficiary will
receive an additional amount through Accidental Death
and Dismemberment (AD&D) coverage.
Additional Life Insurance (paid by you)
It is important to have enough life insurance protection
for your family. If you determine you need more than the
Basic Life coverage, you may want to add coverage for
yourself and your eligible dependents.
To determine how much it will cost for the Additional Life,
log-on to the Online Benefit Enrollment System or the
FHCSD HR Intranet.
ADDITIONAL LIFE INSURANCE
What is the AD&D Benefit?
• AD&D coverage is equal to your life insurance
coverage amount.
• AD&D benefits are payable if you pass away, lose a
limb, or have a loss of speech, hearing, or eyesight
because of a covered accident (either on or off the job)
and the loss occurs within one year of the covered
accident.
The payable amount of your AD&D benefit depends on
the type of loss. In the event of death due to an accident,
your beneficiary(s) may receive both your life and AD&D
benefits.
Note: You will automatically be covered under the Basic
Life Insurance plan.
Designate a Beneficiary!
For You
For Your
Spouse
Coverage is available in $10,000 increments.
Benefit amount is a minimum of $10,000 up to
$500,000.
Guaranteed Issue: $150,000
Coverage is available in $5,000 increments. Benefit
amount is a minimum of $5,000 up to $500,000
(not to exceed 100 percent of your additional life
coverage).
Guaranteed Issue: $25,000
For Your
Children
From live birth through age 25 - $10,000
Guaranteed Issue: $10,000
Guaranteed Issue amounts only apply for newly
eligible employees. If you are electing Additional Life
Insurance outside of when it was first offered to you,
or in amounts over the guaranteed issue, you will be
required to submit a Medical History Statement for
approval by the insurance company before coverage
can become effective.
Don’t forget to designate a beneficiary(s) for your life and
AD&D Benefits.
You can designate beneficiary in the Online Benefit
Enrollment System.
19
Long Term Disability
Long Term Disability
Long Term Disability (LTD) insurance pays you a portion of your income if
you become unable to perform your regular job duties for 90 days due to
illness or injury. FHCSD offers you two levels of coverage:
• Basic LTD plan (paid by FHCSD)
• You will automatically be covered under the Basic LTD plan if you
do not enroll for coverage under the Additional LTD plan.
• Additional LTD plan (paid by you)
What is the Long Term Disability Benefit?
LTD works with Social Security and any other group disability coverage to
provide you with a combined monthly benefit.
Basic LTD Plan (paid by FHCSD)
• You’ll get 50% of your monthly pre-disability earnings, up to $10,000
per month for up to 24 months.
Additional LTD Plan (paid by you)
• You’ll get 60% of your monthly pre-disability earnings, up to $12,000
per month up to your Social Security Normal Retirement Age.
How much does Additional Long Term Disability cost?
To determine how much it will cost for the Additional LTD plan, log-on to
the Online Benefit Enrollment System or the FHCSD HR Intranet.
KNOW WHERE TO START
Even with a healthy lifestyle and preventive care, sometimes an illness or accident can still happen.
If you become disabled, contact The Standard at 800-368-1135 so they can certify your claim and
assist you with the disability claim process.
20
Retirement Saving Plans
403(b) Plan
457(b) Plan
The 403(b) plan gives you the opportunity to save money for your
retirement before taxes are taken out. Eligible employees* may begin
making contributions on the first pay period administratively feasible
(1-2 pay periods generally).
The 457(b) plan is a retirement plan that
is available for governmental and certain
non-governmental employers. The plan
operates similarly to our 403(b) plan and
allows you to save beyond the limits of
the 403(b) plan alone.
How do I enroll?
Employees hired after 1/1/2016 will automatically be enrolled in the
403(b) plan. By default, 6% of your pay will be contributed to the plan.
You can change your contribution amount at any time.
How much can I save?
• You can save from 1% to 50% of your total pay up to the 2016 IRS
annual maximum.
• If you are 50 years or older you may contribute an additional
amount up to the 2016 IRS catch-up contribution maximum.
• The money you contribute is always 100% vested.
When does the money come out of my paycheck?
• Retirement plan contributions are taken out of all 26 paychecks.
Is there a match?
Yes. FHCSD will match 50% of your contribution up to 10% of your
pay. Employee contributions that are over 10% of your pay will not be
matched. The matching contributions FHCSD makes on your behalf will
vest based on the schedule below:
YEARS OF SERVICE
VESTING OF MATCH
Less than 1 year
0%
1 - 2 years
25%
2 - 3 years
50%
3 - 4 years
75%
4 or more years
100%
How is my money invested?
• You have a menu of funds to choose from if you wish to direct your
investments.
• If you do not choose your investment option(s), contributions will
be automatically deposited in the plan’s investment default.
• For detailed information about your investment options, please
contact Principal at www.principal.com or call 800.547.7754.
*You are an eligible employee if you are expected to work at least
1,000 hours per year.
Who can enroll?
• You can enroll in the plan if you hold
the title of:
• Director or are a Licensed
Independent Practitioner
• Have completed 90 days of service
• And work a minimum of 20 hours per
week
How much can I save?
• You can save from 1% to 100% of your
total pay up to the 2016 IRS annual
maximum.
• The money you contribute is always
100% vested.
How is my money invested?
• You have a menu of funds to choose
from if you wish to direct your
investments.
ACCESS YOUR RETIREMENT
PLAN ANYWHERE!
View your retirement
account from the
Principal Financial
Group® anytime and
anywhere – with
this free and secure
mobile app for Apple, Android and
Blackberry.
Search “Principal Financial” in your
app store to download.
21
Additional Benefits
529 CollegeBoundfund Savings Plan
The Section 529 plan through AllianceBernstein allows you
to save money for college. You contribute to an account on
an after-tax basis and use the money to pay for qualified
expenses (e.g., tuition, books, room and board) for you or
your child(ren). Your earnings in the account will be free
from any federal income taxes.
For more details or if you are interested in enrolling, please
contact AllianceBernstein at 800.227.2900 or online at
corporate.collegeboundfund.com.
User ID: FHCSD Password: COLLEGEFUND
UnitedHealthcare Global Travel Assistance
This benefit helps you cope with emergencies when you travel more
than 100 miles from home or internationally for trips of up to 180 days.
You and your family are automatically covered at no cost to you and it
offers the following services 24 hours a day, every day: pre-trip assistance,
trip assistance, medical assistance, legal assistance, 24-hour health
information, emergency transportation services and personal security
services.
For more information, please contact UnitedHealthcare Global at
800.527.0218 or by email at assistance@uhcglobal.com.
Pet Insurance
VPI Pet Insurance offers affordable plans for dogs, cats, birds, reptiles and other
exotic pets. Policies cover a wide range of care from minor ailments to serious
conditions such as cancer and heart disease. Pet owners are free to visit any
veterinarian. VPI has coverage in all 50 states including Washington D.C.
VPI Pet Insurance reimburses for:
• Office visits
• X-rays
• Prescriptions
• Surgeries
• Treatments
• Hospitalization
• Lab fees
• And more!
For more details or if you are interested in enrolling,
please contact VPI at 877.738.7874 or online at
www.petinsurance.com/affiliates/fhcsd.
22
Additional Benefits
LegalShieldTM
You can enroll in the legal assistance plan, which is
designed to help you with many everyday issues, including
traffic violations, credit problems, child custody matters,
and landlord issues.
As a participant in the LegalShield plan, you will have
access to a wide variety of attorneys from top law firms in
your area.
Identity Theft ShieldTM
You have the option to enroll for Identity Theft Shield
identity theft protection. This benefit may save you time
and money - and restore your name and credit for you if
your identity is stolen.
EMPLOYEE COST
PER PAY PERIOD 1
BENEFIT PLAN
LegalShield
Employee, Spouse/DP & Child(ren)
$7.98
Identity Theft Shield
Employee and Spouse/DP
$7.48
LegalShield + Identity Theft Shield
Employee, Spouse/DP & Child(ren)
to age 18
$12.95
DP: Registered Domestic Partner
Except for 4/29/2016 and 9/30/2016 paychecks
1
Trained experts provide you with fraud alert notifications,
perform proactive database searches, and continuously
monitor your credit.
Supplemental Insurance
The following Aflac supplemental plans are available to you.
• Term Life insurance
• Accident Indemnity
• Disability Income Protector
• Cancer Indemnity
• Sickness Indemnity
• Hospital Intensive Care
• Hospital Protection
• Specified Health Event
Contact Bruce Betz at 619.829.2958 for enrollment
information.
Benefits Plus
Home and Auto Insurance Discount Program
With Benefits Plus you may be able to save on quality home, renters and auto insurance. As an employee of FHCSD you
may qualify for special discounts that can save you money. You’ll also have the option to have policy premiums deducted
from your bank account. To obtain a quote or receive more information on this program, all you need to do is call the
Employee Benefits Service Center at extension 4200 or 877.679.2011.
When you call, you will:
• Receive a professional help with choosing the right insurance
• Get a free, no-obligation quote for coverage
To make sure you get an accurate comparison with your current coverage, be sure to have a copy of your policy handy.
23
Work Life Services
Employee Assistance Program
Work Life Services Employee Assistance Program
Because unresolved personal issues can affect every aspect of one’s
life, FHCSD offers you and your family the Work Life Services Employee
Assistance Program, through The Standard, at no cost to you.
What is Work Life Services Employee Assistance Program?
Work Life Services Employee Assistance Program is a confidential
program for you, your family and all household members; it provides:
• Unlimited telephonic access.
• 24-hour crisis response by licensed counselors, seven days a week.
• Each member of your household receives 3 in-person visits per issue
per year.
What can I call about?
Call for confidential assistance with nearly any personal matter you may
be experiencing, including:
• Financial concerns
• Legal concerns
• Substance abuse
• Stress/anxiety
• Grief and loss
• Marital/relationship issues
Counselors can also provide free access to in-person counseling,
dependent care referrals, other community referrals, and written
information. Additional counseling can be integrated with your medical
plan coverage.
HELP WHEN YOU NEED IT!
A single call will connect
you to a specialist who
will provide you with
immediate assistance.
888.293.6948
You can also login to the
website at:
www.eapbda.com
24
Login ID: standard
Password: eap4u
FHCSD Wellness
Your Path to Exceptional Health
At FHCSD, we strive for a company culture that supports a
healthy, active lifestyle. As a valuable member of our team,
your health and quality of life are important to us. That’s
why we’ve implemented Your Path to Exceptional Health.
We encourage you to become actively involved in Your
Path to Exceptional Health and to take advantage of this
fantastic benefit.
How can I get involved?
The Path to Exceptional Health includes many ways to learn and to participate
including:
• Monthly Newsletters produced by our own Prenatal Support Services
department!
• Quarterly team-based health challenges with prizes.
• Participants who complete the challenge for the quarter will receive a
$50 per month Wellness Credit for their medical insurance in the next
quarter!
OUR WELLNESS MISSION
To create a culture that
encourages employees
and their families to adopt
and sustain behaviors that
enhance health and wellbeing and maximize quality
of life.
• Financial wellness classes for employees and their partners.
All employees are encouraged to participate and join us on The Path to
Exceptional Health!
25
Employee Perks
Discounted Care at FHCSD Clinics
As an employee of FHCSD you, and your immediate family members, are eligible to receive discounted services at our
clinic locations (only if you are not otherwise insured). See the table below for a list of discounted services.
DEPARTMENT
EMPLOYEE
DISCOUNT**
EXCEPTIONS
SELF PAY
DEPOSIT
Adults
Pediatrics
Women’s
Dental
Vision Care
Speech, Hearing, Early Int.
ENT
Other Specialties
50%
50%
50%
25%
40%
50%
50%
50%
Yes*
Yes*
Yes*
Yes*
Yes*
No
No
Yes*
$35
$35
$35
Variable**
$65
$45
$45
$45
* Purchased materials/supplies – costs plus handling fee.
X-Ray and Pharmacy are not subject to discount.
Some procedures discounted down to cost, plus handling fee (i.e. lab, glasses frames).
MAXIMUM
SELF - PAY
DISCOUNT***
80%
80%
80%
25%
40%
50%
50%
50%
EXCEPTIONS
Yes*
Yes*
Yes*
Yes*
Yes*
No
No
Yes*
** Depends upon treatment rendered. Typical range is $35.00 to $50.00.
*** Subject to minimum fee of $35.00 as well as income and number of family
members, except for Beach minimum $65.00.
Employee Referral Bonus
A cash bonus is paid to employees who refer an applicant who is hired to work at FHCSD. For more information, see HR
policy and www.fhcsd.jobs.
Service Awards
All regular full-time and part-time employees are eligible to receive a service award upon completion of five years of
service and at the end of every additional five years of service. Service does not have to be continuous to count toward
service credit for the award.
Tuition Reimbursement
FHCSD strongly believes in our Standard of Conduct to Learn, Grow, and Continuously Improve. To support FHCSD
employees seeking professional growth and development of skills necessary to fulfill our mission of providing affordable
quality health care, FHCSD has a Tuition Reimbursement program. For complete program details and how to apply,
please see the Tuition Reimbursement policy on the HR-Benefits website.
Who is eligible?
Tuition Reimbursement is available
for regular employees working 30
hours or more per week.
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How much is the reimbursement?
FHCSD will reimburse up to fifty
percent (50%) of expenses such as
tuition, registration fees, text books,
and lab fees, up to a maximum of
one thousand dollars ($1,000.00) per
fiscal year.
What coursework is eligible?
Coursework must be a part of a
program leading to an certificate
or accreditation, Associate of
Arts, Bachelors, Masters, or other
post-graduate degree related to a
substantive area of the business
of FHCSD (such as medical, dental,
nursing, marketing, accounting,
technology, and so forth).
Employee Perks
Wireless Discounts
Union Bank
AT&T
Benefits include:
• Qualified employees can receive 25% off wireless
voice communication products and data service plans.
• A $50 welcome bonus when you open a new checking
account
• To sign up, visit www.att.com/wireless/premiergpo
and enter your 8-digit Foundation Account Number:
04553393.
• No monthly service charge
• You can also visit any AT&T corporate-owned/standalone store (but not an authorized retail store).
• Free debit card
• The employee must be the primary account holder for
his/her family to be eligible for the discount.
• Mobile Banking
• You will be required to provide proof of employment.
• Free welcome package of checks
• Free online banking and bill pay
• Discounted safe deposit box
Verizon
For more informationm stop by a Union Bank branch, visit
www.unionbank.com or contact Jojo Bondoc at
• Get a 22% discount on Verizon Wireless calling plans
of $34.99 monthly access or higher, 25% discount on
accessories, plus 250 free texts.
619.336.2008. FHCSD’s company ID code is 27777.
Tickets2Fun Discounts
• To register, visit www.verizonwireless.com/discount
and enter your work e-mail address. If you do not have
a work e-mail address, select the appropriate action
under “Don’t Have a Work E-mail Address?”
FHCSD employees can save up to 40% off nationwide
family attractions including:
• You can also visit any Verizon corporate-owned/standalone store (but not an authorized retail store) or call
800.899.4249.
• You will be required to provide proof of employment.
Sprint
Employees (and up to 5 of their family members) can get a
23% discount on their personal cell phone plans.
• Disneyland and California Adventure
• SeaWorld
• Catalina Island Cruises
• Movie Theaters
• Knott’s Berry Farm
• Legoland
• and more!
Here’s how to login & order:
To get the discount:
1. Go to www.tix2fun.com and click Login
1. Call 1-888-233-4831
2. First time New Customers click Register Now…
2. Go to the website www.sprint.com/provista
3. Enter the Partner Code, FHC513
3. G o to a store and show proof of employment
(work ID or paystub)
4. Complete your registration. You’re ready to shop.
For your reference, here are your Sprint codes:
Employee: HHPPI_MM_FSD_ZZZ
Corporate: HHPPI_MM_FSD
5. Your personal password will be emailed to you later.
6. You’re done! Start Shopping and Saving with Tickets 2
Fun
For more information contact: Tickets2Fun 949.683.6851
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Time Off
At FHCSD, we encourage you to have a healthy work/life balance.
Our time off programs are a way for you to relax and recharge so
you can be your best you.
Paid Time Off and Extended Sick Insurance
PTO (Paid Time Off) and ESI (Extended Sick Insurance) are
benefits provided by FHCSD to ensure you have periodic time off
for personal recreation and relaxation or while you or a family
member is recovering from an illness or injury.
Who is eligible?
All regular employees who work 24 or more hours weekly accrue
PTO and ESI credit each pay period based on the percentage of
time or number of hours worked for that particular pay period.
Paid Sick Leave (PSL) - Who is eligible?
Temporary, per diem, and regular part-time
employees working under 24 hours per week who
do not earn PTO or ESI, who work for 30 or more
days within a year. PSL does not apply to regular
or part-time employees who work more than 24
hours per week who accrue PTO.
How do I earn PSL?
• You will earn at least one hour of PSL for
every 30 hours worked.
• The total accrual will be capped at 48 hours
per calendar year.
• Employees can only use 3 days
(24 hours) per year.
How do I earn PTO?
PTO ACCRUAL RATE
YEARS OF
SERVICE
DAYS PER YEAR
HOURS PER PAY
PERIOD
0 to 4 years
16 days (128 hours)
4.93 hours
5 to 9 years
19 days (152 hours)
5.85 hours
10+ years
22 days (176 hours)
6.78 hours
The maximum PTO accrual is 320 hours. Contact Human Resources for
Manager, Director and Provider level PTO accrual rates.
ESI1
In most cases, ESI is used for illnesses or injuries that last three or
more days. The first two days of illness is usually paid from your PTO
bank (if available). Three days of ESI may be used for bereavement of
the death of a family member. Family members include child, spouse
and parent.
How do I earn ESI?
• Full-time regular employees earn 3 days (24 hours) per year of ESI.
• ESI accrues at a rate of 0.92 hours per pay period.
• ESI hours are available for use as they are earned each pay period.
• You can earn up to a maximum of 720 hours.
Employees who have not completed their orientation period accrue PTO/ESI
during orientation time, but are not allowed to use PTO/ESI until successful
completion of that period.
• Accruals cannot be used until the 90th
day of employment.
• Unused PSL hours will not be paid out
at the end of employment.
• If an employee terminates employment and
is rehired within one year, prior accrued PSL
hours balance will be reinstated.
Holidays*
Each year FHCSD observes a number of paid
holidays, giving you the opportunity to spend
quality time with family and friends. The
following holidays will be observed in 2016:
• New Year’s Day
• Thanksgiving Day
• Memorial Day
• Day after Thanksgiving
• Independence Day • Christmas Day
• Labor Day
• Birthday Holiday**
*Regular employees who work at least 24 hours per week are
eligible for holiday pay from commencement of employment.
Holiday hours will be paid to an eligible part-time employee
only when a holiday falls on a day that he/she works on a
regular basis and at the same number of hours regularly
scheduled that day.
1
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**All regular employees who work 40 hours per week are
eligible to take their birthday as a paid holiday. Birthday
holidays will not be granted until successful completion of
the orientation period.
Safety
Safety Starts With Me
Create and maintain a culture of safety that values and demonstrates
behavior to promote a safe environment for all.
• Our Be Alert! Don’t Get Hurt! Safety and Recognition Program encourages
employee participation in improving safety in the workplace, and rewards and
acknowledges employees who take action and provide solutions for workrelated safety issues.
• Safety Kudos - You can give a co-worker a Safety Kudos ticket whenever you
observe them taking safety measures in their daily work activities.
• Safety Quest - On a quarterly basis, you will have access to an on-line safety
quest for safety information. All entries submitted with a score of 100% will be
entered into a drawing for prizes.
• Safety Suggestions - The employee who submits the best safety suggestion
each quarter will receive an award.
CPR Certification
CPR Certification class offered every other month at Gateway.
Safety Training
Regular safety trainings offered throughout the year.
Ergonomics
Free ergonomic assessments and tools available for all employees!
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Helpful Definitions
What Does It Mean?
Employee Contribution: The amount an employee pays for
their benefits through payroll deductions.
Copayment: The amount which a covered individual is
required to pay for certain services after meeting any
applicable deductible.
Deductible: The amount of out-of-pocket expenses that
must be paid for services by the insured before becoming
payable by the carrier.
Eligibility: Conditions that an employee must meet to
participate in a plan or obtain a benefit.
Medical Group (network): An organization of physicians who
are generally located in the same facility or participate in a
group network and provide services to covered individuals.
Member: A person eligible to receive, or receiving, benefits
from an insurance policy. Includes both those who have
enrolled or subscribed and their eligible dependents.
Non-Formulary: A drug or medication not listed and
approved on a health insurance plan coverage schedule.
Enrollment Period: The period of time you have to sign up
for insurance.
Out-of-Network: A healthcare provider with whom an
insurance carrier does not have a contract to provide services.
A member may pay higher copays, and/or deductibles to see
an out-of-network provider or have no coverage at all.
Formulary: A list containing the names of certain
prescription drugs that a medical plan covers when
dispensed to its members who have drug coverage.
Out-of-Pocket Maximum: The maximum amount of money
a person will pay in addition to copays and deductibles, in a
calendar year.
Guaranteed Issue: The amount of life insurance coverage
you are guaranteed to receive without the requirement of
medical history or examination.
Outpatient: A person who visits a clinic, emergency room
or health facility and receives health care without being
admitted as an overnight patient.
Health Savings Account: A personal savings account that
allows you to pay for qualified medical expenses with taxadvantaged dollars. You and/or your employer contribute
money to an HSA through pre-tax contributions. The
money contributed to the account is not subject to federal
income tax at the time of deposit.
PCP: Primary Care Physician (PCP) provides treatments for
routine illness and injuries. For members enrolled in an HMO
Plan, a PCP will need to refer the member to a specialist.
HMO: Health Maintenance Organizations (HMO) offer a
range of health care services at a fixed price and require
that covered individuals see doctors that are in their
network of providers. HMOs require a referral to network
providers after the member has selected a Primary Care
Physician.
In-Network: Medical, dental and vision providers or
facilities who have agreed to discounted fees with
insurance carriers to participate within their provider
networks.
Inpatient: A person who occupies a hospital bed, crib
or bassinet while under observation, care, diagnosis or
treatment for at least 24 hours.
Mail Order Prescriptions: A method of dispensing
medication directly to the patient through the mail by
means of a mail-order drug distribution company. Offers
greatly reduced costs for prescriptions, especially for long
term drug therapy.
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PPO: Preferred Provider Organizations (PPO) have a network
of providers whose services are available to members at
lower cost that services of out-of-network providers. PPOs
allow members to self-refer to any network provider at any
time.
Premium: The amount of money an insurance company
charges for insurance coverage. Reasonable & Customary: The prevailing charge made by
physicians of similar expertise for a similar procedure in a
particular geographic area.
Wellness: A healthy balance of the mind, body and spirit that
results in an overall feeling of well-being and leads to a high
quality of life.
Employee Benefits Service Center
My plan didn’t
pay my bill.
What do I do?
When is Open
Enrollment?
Is my provider
in-network?
I lost my
ID card!
Who is eligible
for benefits on
my plan?
How does my
plan work?
Can I have
double
coverage?
I can’t enroll...
help!
YOUR EMPLOYEE BENEFITS SERVICE CENTER IS HERE TO HELP
YOUR EMPLOYEE BENEFITS SERVICE CENTER is the only call you need to make with employee benefit and wellness questions.
The Family Health Centers of San Diego Employee Benefits Service Center is here to answer your questions and help
make your employee benefits easier to use. The Benefits Service Center is the only call you need to make for employee
benefit and wellness questions...and best of all, it’s free!
Within 24 hours of your initial call, the Service Center will either have the issue resolved or will update you on any
further actions including the time frame for resolution. Below are some of the questions the Service Center can answer.
Benefit Questions
I need to have surgery; does my insurance cover it? How much
will my portion of the cost be?
Claims Assistance
I received a bill from my doctor. I thought these services were
covered. What do I do now?
Referrals
I need to see a specialist, but I’m having trouble getting
referral. What do I do?
Eligibility Issues
EXTENSION 4200
or 877.679.2011
champion@intercaresolutions.com
Fax: 866.214.2211
Monday - Friday
7:00 a.m. to 5:30 p.m. PT
a
All inquiries will be responded to within
24 hours of your call or e-mail.
I tried to pick up a prescription today, but the pharmacy is saying
that I’m not covered. Why?
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Important Notices
The following important notices can be found on the FHCSD Intranet.
• CA Maternity Coverage
• Continuation of Benefits under COBRA
• Family Health Centers Summary Plan Wrap Document
• Genetic Information Nondiscrimination Act (GINA)
• Health Exchange Notice
• Medicaid and the Children’s Health Insurance Program (CHIP)
• Medicare Part D Creditable Coverage
• Newborn And Mothers Health Protection (Out of CA) Act Of 1996
• Patient Protection (Primary Care Physician (PCP) and OB/Gyn selection)
• Privacy Rights
• Qualified Medical Child Support Orders (QMCSO)
• Special Open Enrollment Rights for Certain Individuals under Health Insurance Portability and Accountability Act of
1996 (HIPAA)
• Summary of Benefits Coverage (SBC)
• Wellness Plan Notice
• Women’s Health & Cancer Rights Act
Additional important carrier information will be provided to you after you enroll.
This guide is intended to provide an overview only of the benefits offered by Family Health Centers of San Diego. It is not an
offer of coverage or intended to offer medical advice. It does not contain all plan provisions, limitations and exclusions. Consult
your plan documents (Schedule of Benefits, Certificate of Coverage, Group Insurance Certificate, Booklet, Booklet-Certificate,
Group Policy) to determine governing contractual provisions relating to your plan. In the event of a conflict between this guide
and your plan document, the plan documents will always govern.
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IMPORTANT CONTACT INFORMATION
BENEFIT
Employee Benefits Service
Center
Online Benefit Enrollment
System
Medical
CARRIER
N/A
N/A
WEB ADDRESS / E - MAIL
N/A
Extension 4200
or
877.679.2011
champion
@intercaresolutions.com
N/A
UnitedHealthcare SignatureValue
Advantage HMO (Limited
Network)
525640
UnitedHealthcare
SignatureValue HMO
(Full Network)
525638
844.886.2391
User Name: FHCSD + 4-digit
badge number
800.624.8822
uhcwest.com
Mail Order Prescriptions
N/A
800.562.6223
prescriptionsolutions.com
Kaiser Permanente HMO
116102
800.464.4000
kp.org
820
800.424.4652
simnsa.com
743272
866.633.2446
myuhc.com
N/A
800.357.6246
hsabank.com
United Concordia DHMO
903055001
866.357.3304
ucci.com
United Concordia DPPO
903055000
800.332.0366
ucci.com
820
800.424.4652
simnsa.com
30028835
800.877.7195
vsp.com
UnitedHealthcare PPO with HSA
Dental
PHONE
NUMBER
vbas.com
SIMNSA HMO
Health Savings Account
GROUP
NUMBER
HSA Bank
SIMNSA DHMO
Vision
Vision Service Plan PPO
Flexible Spending Accounts
(FSA)
WageWorks
31214
855.774.7441
wageworks.com
Life/AD&D
The Standard
643599
800.628.8600
standard.com
Long Term Disability (LTD)
The Standard
643599
800.368.1135
standard.com
403(b) Plan
Principal Financial Group
446501
800.547.7754
principal.com
457(b) Plan
Principal Financial Group
610033
800.547.7754
principal.com
703584
800.227.2900
collegeboundfund.com
(general info)
corporate.collegeboundfund.com
User ID: FHCSD
Password: COLLEGEFUND
529 Savings Plan
AllianceBernstein
CollegeBoundfund
Pet Insurance
VPI
N/A
877.PETS.VPI
(877.738.7874)
petinsurance.com/affiliates/
fhcsd
Travel Assistance
UnitedHealthcare Global
Travel Assistance
N/A
800.527.0218
assistance@uhcglobal.com
Legal Services
LegalShield
14257
800.654.7757
legalshield.com
Identity Theft
Identity Theft Shield
14257
888.494.8519
legalshield.com
Aflac Supplemental Benefits
Aflac
RH826
800.992.3522
aflac.com
Home, Renters & Auto
Insurance
Benefits Plus
N/A
877.679.2011
champion
@intercaresolutions.com
Work Life Services
The Standard
Employee Assistance Program
N/A
888.293.6948
eapbda.com
Login ID: standard
Password: eap4u
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